Aristide Foundation for Democracy In collaboration with social workers and doctoral students from the University of Michigan

The massive earthquake of January 2010 and ensuing challenges associated with settlement of camps for internally displaced people (IDP) have resulted in enormous mental health need among residents of Port-au-Prince. Quantitative survey data and qualitative interviews conducted with residents of IDP camps as part of a UN-funded post-disaster assessment have revealed that many residents report psychological and emotional difficulties. These difficulties are not restricted to a few seriously mentally ill individuals; rather problems with hypervigilance, startle response, sleep, intrusive memories, fear, anxiety, grief, and anger are widespread among the general public. Unfortunately, Port-au-Prince lacks the basic infrastructure needed to quickly train and employ sufficient numbers of mental health workers to provide such services to displaced individuals in Port-au-Prince.

To aid in this process, we have started Soulaje Lespri Moun – Relief for the Spirit, a collaboration between the Aristide Foundation for Democracy and social workers and doctoral students from the University of Michigan. Our goal is to create a sustainable system of training and service provision, in which Haitians train Haitians to provide basic psycho-education and skills groups in camps and throughout the city. This is not an effort to train mental health professionals with the skills needed to work with the seriously mentally ill (although this is needed, too). Rather, it is a movement toward widespread dissemination of education and coping skills to benefit the general public. We propose that some symptoms of posttraumatic stress among the public can be alleviated through basic psychoeducation about common reactions to trauma paired with training in relaxation and other coping strategies. We propose a one-time educational group intervention aimed at decreasing stigma, shame, fear, and self-blame and increasing ongoing healing communication among traumatized individuals. Moreover, the intervention will provide training in basic relaxation and self-soothing techniques designed to reduce symptoms of physiological hyperarousal and thus decrease anxiety, fear, irritability, startle response, bodily aches and pains, and sleep difficulty. We will utilize a group treatment model, a cost-effective method particularly well-suited for disaster areas in which need cannot be efficiently met by one-on-one treatment. Further, the intervention, developed in part by Haitian earthquake survivors and a Haitian psychologist, utilizes a culturally-appropriate, non-stigmatizing approach.

We understand that that the earlier the intervention, the more effective it is likely to be preventing chronic PTSD symptoms Thus, time and cost efficiency is critical for this project. To this end, we will train Haitian lay mental health workers who will work as teachers of a culturally-appropriate psycho-education and coping skills curriculum to residents of IDP camps. In doing so, we aim to make free, widespread basic mental health services available as quickly as possible. Moreover, we intend to satisfy a secondary goal of providing income, education, and training to young Haitian high-school and college graduates who will work as our lay mental health workers, supervisors, and research assistants –at a time when Haiti’s economy has all but collapsed. This initial team will train and supervise others, and we hope eventually to merge with the Institute of Social Work and Social Science, a proposed bachelor’s level degree-granting program in Port-au-Prince designed to train professional social workers. A coalition of Haitian social service providers is currently working in collaboration with the University of Michigan and UniFa (the University of the Aristide Foundation) to create this Institute. We aim to create a self-sufficient system that will ultimately be managed entirely by Haitian staff.

Finally, we aim also to contribute to the body of empirical research on post-disaster mental health intervention. We aim to evaluate the effectiveness of our model through ongoing research, with the goal of improving the current model as well as developing an intervention model with applicability in a range of cultural contexts. We have two hypotheses regarding the efficacy of the intervention: first that it will decrease symptoms of post-traumatic stress for participants in the one-time class (residents of the IDP camps) and second, that it will decrease such symptomology for those implementing the class (the lay mental health workers). More specifically, our first hypothesis proposes that even one-time exposure to basic information about common reactions to trauma can decrease the sense that one is “alone” or “going crazy” and increase ongoing healing communication among traumatized individuals, while one-time training in basic breathing and imagery relaxation skills can significantly reduce physiological symptoms. Our second hypothesis is based in the theory that re-entering a traumatizing situation in an efficacious and prosocial role can increase perceived control and self-efficacy and therefore promote healing. Thus, we expect that our lay mental health workers will benefit not only from learning the content of the curriculum, but from the very act of implementing the intervention. We are committed to an ongoing research agenda to test these predictions, and to revise and improve our model. If the model proves effective, we aim to assess applicability to other post-disaster contexts.

To develop an effective, culturally-appropriate protocol for presenting mental health education, coping skills, and relaxation techniques in a group setting and to evaluate the effectiveness of this model in reducing symptoms of PTSD and depression among recipients of the intervention AND among the lay mental health workers implementing the intervention.

To provide practical training and employment to unemployed Haitians

To create a sustainable system of lay mental health provision which will ultimately be maintained entirely by Haitian organizations and workers

To establish a safe and efficient pathway for US volunteer mental health professionals who will provide ongoing training to lay mental health workers

To merge the lay mental health worker project with a school of social work to be developed in Port-au-Prince